Dental Office Time Management and Patient Care Series: Ultra Fast Periodontal Charting

Let’s just admit that periodontal charting is not the most fun thing to do. Here’s a short list of why:

  1. It soaks up valuable clinical time
  2. It is done as much for legal reasons as clinical reasons
  3. The clinical use of the data is limited
  4. Many clinicians only chart pocket depth (PD).  But, unless one notes both the position of the gingival margin (GM) relative to the cemento-enamel-junction (CEJ) and then pocket depth (PD) relative to the GM, the PD charting does not track clinical attachment loss or gain.  Inputting both takes time.
  5. Charting GM levels and PD measurements in two separate passes is clinically illogical and not as revealing as charting both the GM and PD at the same time at the same site while progressing through a quadrant.
  6. User interfaces are often cluttered and difficult to use

What are a few ways to make this better?  View a short VIDEO outlining the points below

  • “Mass charting” of the basic elements: record GM, PD, plaque, supragingival and subgingival calculus in seconds to get a baseline of key variables. In practices with effective hygiene departments, most patients do not require full mouth site-by-site periodontal charting because they have few areas of recession and few pockets that may represent a potential loss of clinical attachment. Nonetheless you must have records of the probing in the patient record and a usable periodontal charting must show both GM and PD.  A system that will input these parameters in all four quadrants in just a few seconds is ideal and a big time saver. If there are problem areas you can come back after you get your baseline and update the readings.
  • Get reports that show only the value changes of the PD, GM and CAL from previous readings. After updating a periodontal chart, the clinician is specifically looking for changes since the last probing.  Having a program that will remove the clutter and show only the changes (good or bad) is ideal, because that saves time and points the clinician to areas of interest.
  • A graph of changes in the patient’s plaque, bleeding and pocket readings that are easily visualized over time. Clinicians should have readily available data that is drawn from charting that shows patients the long term presentation of key indicators of interest in oral health – plaque accumulation, bleeding, pockets.  The patient and clinical staff can use the data to help make recommendations and secure patient loyalty to the program.
  • Gain clinical knowledge through charting:  imagine yourself moving site by site completely around the mouth recording the GM at and then repeating the procedure recording PD.  What have you gained in terms of clinical knowledge?  Not much because the procedure is geared towards inputting numbers rather than gaining clinical knowledge.  Try this: Begin at a most posterior buccal site in the maxilla and call out the GM position relative to the CEJ (normal is 0).  Next move the explorer superiorly into the pocket and measure the length of the PD (while still at the site) and call out that number (normal is around 3 mm.)  If you do this for the entire quadrant, you will find that you have gained actual clinical knowledge for that entire quadrant that will help lead towards a treatment recommendation.  You will find immediately that you will cannot help but visualize the actual clinical picture that includes recession, pocket, bleeding, suppuration if present, attached tissue quantity and other parameters of interest.  A charting system that enables this is extremely helpful.
  • Newer designs of periodontal charting that are pleasant to look at that separate GM/PD/CAL charting from accretions on the teeth in a way that provides easy visual understanding of the presentation. Emphasizing value changes over time while using a framework that enables this rather than emphasizing dental anatomy makes for easier viewing and understanding.  All clinicians know dental anatomy, so trying to squeeze data into areas according dictates of that only makes charting interfaces harder to use.

Unfortunately periodontal disease is prevalent and many of our patients still suffer with it.  Newer treatment modalities such as bone and soft tissue grafts make effective periodontal charting even more important than ever, so the clinician can easily detect incremental changes that occur over time. Improved periodontal charting tools that enable care save time and move the patient more quickly to treatment.